Factors Associated with Mortality in Patients New To Haemodialysis
Factors Associated with Mortality in Patients New To Haemodialysis
Background. Patients receiving dialysis therapy for end-stage kidney failure have a high cardiovascular mortality that can only be partially explained by traditional risk factors.
Methods. This study was a post hoc analysis of a prospectively gathered data set from a randomized trial comparing outcomes in new haemodialysis patients treated with sevelamer or calcium-containing phosphate binders. Patients were followed from the time of enrollment until death or censor on 31 December 2005. Median follow-up was 3.6 years. Demographics, cardiovascular risk factors, laboratory data, medication use and severity of vascular calcification were available at baseline and over the first 18 months of dialysis.
Results. Baseline predictors of mortality included age, creatinine, heart rate, iPTH, C-reactive protein (CRP), coronary and aortic calcium scores and the presence of aortic valve calcification. Over the first 18 months, averages of diastolic blood pressure, BUN, creatinine, albumin, phosphorus, iPTH and CRP were all significantly different between survivors and non-survivors. A stepwise multivariable adjusted Cox regression model demonstrated that low BUN and albumin and high CRP along with the use of calcium-containing phosphate binders (rather than sevelamer) were the strongest predictors of mortality in patients new to haemodialysis.
Conclusions.These findings suggest that non-traditional risk factors, such as inflammation and malnutrition measured during the first 18 months of dialysis, are important determinates of survival in new dialysis patients. In addition, the unique risk factor for dialysis patients, the use of calcium-containing phosphate binders, was associated with a higher mortality rate in patients new to dialysis.
Patients receiving dialysis therapy for end stage renal disease (ESRD) have a high cardiovascular mortality that can only be partially explained by traditional risk factors such as age, diabetes, hypertension and lipid disorders. Observational analyses of several large dialysis provider databases suggest that non-traditional risk factors such as albumin, creatinine and markers of inflammation are associated with outcome in this patient population. In addition, disorders of mineral metabolism have gained increased recognition as potentially modifiable risk factors in ESRD. This includes serum calcium and phosphorus concentrations, active vitamin D sterol use, intact parathyroid hormone levels, as well as the extent of coronary artery and vascular calcification. The purpose of the present study was to evaluate the association between baseline demographic, laboratory data and coronary and aortic calcification, as well as laboratory data and medication use in the first 18 months of dialysis and mortality in a cohort of patients new to haemodialysis who had been randomized to sevelamer or calcium-containing phosphate binders. Results from this post hoc analysis are intended to be hypothesis generating and statistically significant findings need to be confirmed by prospective trials.
Background. Patients receiving dialysis therapy for end-stage kidney failure have a high cardiovascular mortality that can only be partially explained by traditional risk factors.
Methods. This study was a post hoc analysis of a prospectively gathered data set from a randomized trial comparing outcomes in new haemodialysis patients treated with sevelamer or calcium-containing phosphate binders. Patients were followed from the time of enrollment until death or censor on 31 December 2005. Median follow-up was 3.6 years. Demographics, cardiovascular risk factors, laboratory data, medication use and severity of vascular calcification were available at baseline and over the first 18 months of dialysis.
Results. Baseline predictors of mortality included age, creatinine, heart rate, iPTH, C-reactive protein (CRP), coronary and aortic calcium scores and the presence of aortic valve calcification. Over the first 18 months, averages of diastolic blood pressure, BUN, creatinine, albumin, phosphorus, iPTH and CRP were all significantly different between survivors and non-survivors. A stepwise multivariable adjusted Cox regression model demonstrated that low BUN and albumin and high CRP along with the use of calcium-containing phosphate binders (rather than sevelamer) were the strongest predictors of mortality in patients new to haemodialysis.
Conclusions.These findings suggest that non-traditional risk factors, such as inflammation and malnutrition measured during the first 18 months of dialysis, are important determinates of survival in new dialysis patients. In addition, the unique risk factor for dialysis patients, the use of calcium-containing phosphate binders, was associated with a higher mortality rate in patients new to dialysis.
Patients receiving dialysis therapy for end stage renal disease (ESRD) have a high cardiovascular mortality that can only be partially explained by traditional risk factors such as age, diabetes, hypertension and lipid disorders. Observational analyses of several large dialysis provider databases suggest that non-traditional risk factors such as albumin, creatinine and markers of inflammation are associated with outcome in this patient population. In addition, disorders of mineral metabolism have gained increased recognition as potentially modifiable risk factors in ESRD. This includes serum calcium and phosphorus concentrations, active vitamin D sterol use, intact parathyroid hormone levels, as well as the extent of coronary artery and vascular calcification. The purpose of the present study was to evaluate the association between baseline demographic, laboratory data and coronary and aortic calcification, as well as laboratory data and medication use in the first 18 months of dialysis and mortality in a cohort of patients new to haemodialysis who had been randomized to sevelamer or calcium-containing phosphate binders. Results from this post hoc analysis are intended to be hypothesis generating and statistically significant findings need to be confirmed by prospective trials.
